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Blood transfusion and hepatitis: still a threat?

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Summary

The incidence of post-transfusion hepatitis (PTH) in recipients of blood products is reviewed. PTH was observed in 10%–12% of recipients of blood products in the United States, 2%–4% in northern Europe and 15%–20% in southern Europe. All studies indicate that 80%–90% of all PTH cases are attributed to non-A/non-B. At least 40% of the patients with PTH non-A/non-B will develop chronic hepatitis or cirrhosis. No specific tests for the detection of the non-A/non-B agent(s) exist. However, several independent studies indicate that part of the donors carrying the infectious non-A/non-B agent have increased levels of alanine amino transferase (ALT). When donors are excluded with elevated ALT values, it is estimated that about 30% of the PTH non-A/non-B cases would be prevented. Some studies indicate that anti-hepatitis B core (anti-HBc) positive donors may carry an increased risk to transmit the non-A/non-B agent, but more recent studies do not confirm this. There is hope that a specific non-A/non-B test will be developed soon.

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References

  1. Aach, RD, Kahn RA (1980) Posttransfusion hepatitis: current perspectives. Ann Int Med 92: 539–546

    Google Scholar 

  2. Aach RD, Lander JJ, Sherman LA, Miller WV, Kahn RA, Gitnick GL, Hollinger FB, Werch J, Szmuness W, Stevens CE, Kellner A, Weiner JM, Mosley JW (1978) Transfusion-transmitted viruses: interim analysis of hepatitis among transfused and nontransfused patients. In: Vyas GN, Cohen SN, Schmid R (eds) Viral hepatitis. Franklin Institute Press, Philadelphia, pp 383–396

    Google Scholar 

  3. Aach RD, Szmuness W, Mosley JW, Hollinger FB, Kahn RA, Stevens CE, Edwards VM, Werch J (1981) Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients. N Engl J Med 304: 989–993

    Google Scholar 

  4. Alter HJ, Holland PV, Purcell RH, Lander JJ, Feinstone SM, Morrow AG, Schmidt PJ (1972) Posttransfusion hepatitis after exclusion of commercial and hepatitis-B antigenpositive donors. Ann Int Med 77: 691–699

    Google Scholar 

  5. Alter HJ, Purcell RH, Holland PV, Feinstone SM, Morrow AG, Moritsugu Y (1975) Clinical and serological analysis of transfusion-associated hepatitis. Lancet II: 838–841

    Google Scholar 

  6. Alter HJ, Purcell RH, Holland PV, Alling DW, Koziol DE (1981) Donor transaminase and recipient hepatitis. Jama 246: 630–634

    Google Scholar 

  7. Anderson M, Murray-Lyon IM, Coleman JC, McCaul TF, Bird RG, Tovey G, Zuckerman AJ (1982) Non-A, non-B hepatitis: a case report. J Med Virol 9: 217–229

    Google Scholar 

  8. Arico S, Aragona M, Rizzetto M, Caredda F, Zanetti A, Marinucci G, Diana S, Farci P, Arone M, Caporaso N, Ascione A, Dentico P, Pastore G, Raimondo G, Craxi A (1985) Clinical significance of antibody to the hepatitis delta virus in symptomless HBsAg carriers. Lancet II: 356–358

    Google Scholar 

  9. Aymard JF, Janot C, Gayet S, Guillemin C, Canton P, Gaucher P, Streiff F (1986) Post-transfusion non-A, non-B hepatitis after cardiac surgery. Vox Sang 51: 236–238

    Google Scholar 

  10. Beasley RP (1982) Hepatitis-B virus as the etiologic agent in hepatocellular carcinoma-epidemiologic considerations. Hepatology [Suppl] 2: 21S-26S

    Google Scholar 

  11. Berman M, Alter HJ, Ishak KG, Purcell RH, Jones EA (1979) The chronic sequelae of non-A, non-B hepatitis. Ann Int Med 91: 1–6

    Google Scholar 

  12. Blumberg BS, Gerstley BJS, Hungerford DA, London WT, Sutnick AI (1967) A serum antigen (Australia antigen) in Down's syndrome, leukemia and hepatitis. Ann Int Med 66: 924–931

    Google Scholar 

  13. Brechot C, Hadchouel M, Scotto J, Fonck M, Potet F, Vyas GN, Tiollais P (1981) State of hepatitis B virus DNA in hepatocytes of patients with hepatitis B surface antigenpositive and -negative liver diseases. Proc Natl Acad Sci USA 78: 3906–3910

    Google Scholar 

  14. Burrell CJ, Gowans EJ, Rowland R, Hall P, Jilbert AR, Marmion BP (1984) Correlation between liver histology and markers of hepatitis B virus replication in infected patients: a study by in situ hybridization. Hepatology 4: 20–24

    Google Scholar 

  15. Collins JD, Bassendine MF, Codd AA, Collins A, Ferner RE, James OFW (1983) Prospective study of post-transfusion hepatitis after cardiac surgery in a British centre. Br Med J 287: 1422–1424

    Google Scholar 

  16. Colombo M, Mannucci PM, Carnelli V, Savidge GF, Gazengel C, Schimpf K (and the European study group) (1985) Transmission of non-A, non-B hepatitis by heattreated factor VIII concentrate. Lancet II: 1–4

    Google Scholar 

  17. Cossart YE, Kirsch S, Ismay SL (1982) Post-transfusion hepatitis in Australia. Lancet I: 208–213

    Google Scholar 

  18. Dienstag JL (1983) Non-A, non-B hepatitis. I. Recognition, epidemiology, and clinical features. Gastroenterology 85: 439–462

    Google Scholar 

  19. Desmyter J, Colaert J, Groote G de, Reynders M, Reerink-Brongers EE, Lelie PN, Dees PJ, Reesink HW (Leuven Renal Transplantation Collaborative Group) (1983) Efficacy of heat-inactivated hepatitis-B vaccine in haemodialysis patients and staff: double-blind, placebo controlled trial. Lancet II: 1323–1327

    Google Scholar 

  20. Dienstag JL (1983) Non-A, non-B hepatitis. II. Experimental transmission, putative virus agents and markers, and prevention. Gastroenterology 85: 743–768

    Google Scholar 

  21. Dike AE (1981) Post-transfusion hepatitis B transmitted by HBsAg negative blood containing anti-HBc. Med Lab Sci 38: 415–417

    Google Scholar 

  22. Farci P, Smedile A, Lavarini C, Piantino P, Crivelli O, Caporaso N, Toti M, Bonino F, Rizzetto M (1983) Delta hepatitis in inapparent carriers of hepatitis B surface antigen. Gastroenterology 85: 669–673

    Google Scholar 

  23. Freiman J, Eckstein R, McCaughan G, Parsons C, Davies JS, Diegutis P, Burnett L, Gallagher N (1985) Significance of serum and hepatic markers of hepatitis B viral infection in HBsAg-positive and HBsAg-negative chronic active hepatitis. Hepatology 5: 50–53

    Google Scholar 

  24. Goldfield M, Black HC, Bill J, Srihongse, S, Pizzuti W (1975) The consequences of administering blood pretested for HBsAg by third generation techniques: a progress report. Am J Med Sci 270: 335–342

    Google Scholar 

  25. Goldfield M, Bill J, Colosimo F (1978) The control of transfusion-associated hepatitis. In: Vyas GN, Cohen SN, Schmid R (eds) Viral Hepatitis. Franklin Institute Press, Philadelphia, pp 405–414

    Google Scholar 

  26. Grillner L, Bergdahl S, Jyrälä A (1982) Non-A, non-B hepatitis after open-heart surgery in Sweden. Scand J Infect Dis 14: 171–175

    Google Scholar 

  27. Hay CRM, Preston FE, Triger DR, Underwood JCE (1985) Progressive liver disease in haemophilia: an understated problem? Lancet I: 1495–1498

    Google Scholar 

  28. Hernández JM, Piqueras J, Carrera A, Triginer J (1983) Posttransfusion hepatitis in Spain. A prospective study. Vox Sang 44: 231–237

    Google Scholar 

  29. Hollinger FB, Khan NC, Oefinger PE, Yawn DH, Schmulen AC, Dreesman GR, Melnick JL (1983) Posttransfusion hepatitis type A. Jama 250: 2313–2317

    Google Scholar 

  30. Hollinger FB, Dolana G, Thomas W, Gyorky F (1984) Reduction in risk of hepatitis transmission by heat-treatment of a human factor VIII concentrate. J Infect Dis 150: 250–262

    Google Scholar 

  31. Hoofnagle JH, Seeff LB, Buskell Bates Z, Gerety RJ, Tabor E (1978) Serologic responses in HB. In: Vyas GN, Cohen SN, Schmid R (eds) Viral hepatitis. Franklin Institute Press, Philadelphia, pp 219–242

    Google Scholar 

  32. Horowitz B, Wiebe ME, Lippin A, Stryker MG (1985) Inactivation of viruses in labile blood derivates. I. Disruption of lipid-enveloped viruses by tri(n-butyl) phosphate detergent combinations. Transfusion 25: 516–522

    Google Scholar 

  33. Horowitz B, Wiebe ME, Lippin A, Vandersande J, Stryker MH (1985) Inactivation of viruses in labile blood derivates. II. Physical methods. Transfusion 25: 523–527

    Google Scholar 

  34. Katchaki JN, Siem TH, Brouwer R, Loon van AM, Logt JTM van der (1981) Posttransfusion non-A, non-B hepatitis in the Netherlands. Br Med J 282: 107–108

    Google Scholar 

  35. Koziol DE, Holland PV, Alling DW, Melpolder JC, Solomon RE, Purcell RH, Hudson LM, Shoup FJ, Krakauer H, Alter HJ (1986) Antibody to hepatitis B core antigen as a paradoxical marker for non-A, non-B hepatitis agents in donated blood. Ann Int Med 104: 488–495

    Google Scholar 

  36. Lander JJ, Gitnick GL, Gelb LH, Aach RD (1978) Anticore antibody screening of transfused blood. Vox Sang 34: 77–80

    Google Scholar 

  37. Lelie PN, Reesink HW, Lucas CJ (1987) Inactivation of 12 viruses by heating steps applied during manufacture of a hepatitis B vaccine. J Med Virol 23: 297–301

    Google Scholar 

  38. Purcell RH, Ticehurst JR (1988) Enterically transmitted non-A, non-B hepatitis: epidemiology and clinical characteristics. In: Zuckerman AJ (ed) Viral hepatitis and liver disease. Alan R. Liss, New York, pp 131–137

    Google Scholar 

  39. Purcell RH, Gerin JL, Popper H, London WT, Cicmanec J, Eichberg JW, Newman J, Hrinda ME (1985) Hepatitis B virus, hepatitis non-A, non-B virus and hepatitis delta virus in lyophilized antihemophilic factor: relative sensitivity to heat. Hepatology 5: 1091–1099

    Google Scholar 

  40. Reesink HW (1980) Studies on transmission and prevention of hepatitis B. PhD thesis, University of Amsterdam

  41. Reesink HW, Leentvaar-Kuypers A, Poel CL van der, Lelie PN, Pietersz RNI, Mulder-Folkerts DKF, Pieters T, Ende A van den, Schaasberg W, Coutinho RA (1988) Non-A, non-B posttransfusion hepatitis in open heart surgery patients in the Netherlands: preliminary results of a prospective study. In: Zuckerman AJ (ed) Viral hepatitis and liver disease. Alan R. Liss, New York, pp 558–560

    Google Scholar 

  42. Rizzetto M, Canese MG, Arico S, Crivelli O, Trepo C, Bonino F, Verme G (1977) Immunofluorescence detection of new antigen-antibody system (delta/anti-delta) associated to hepatitis B virus in liver and in serum of HBsAg carriers. Gut 18: 997–1003

    Google Scholar 

  43. Rosina F, Saracco G, Rizzetto M (1985) Risk of posttransfusion infection with the hepatitis delta virus. N Engl J Med 312: 1488–1491

    Google Scholar 

  44. Shikata T, Karasawa T, Yano M, Oda T (1982) Strategy of application in Asian-African countries and Japanese: pilot study in chimpanzees. In: Szmuness W, Alter HJ, Maynard JE (eds) Viral hepatitis. Franklin Institute Press, Philadelphia, pp 399–410

    Google Scholar 

  45. Smedile A, Farci P, Verme G, Caredda F, Cargnel A, Caporaso N, Dentico P, Trepo C, Opolon P, Gimson A, Vergani D, Williams R, Rizzetto M (1982) Influence of delta infection on severity of hepatitis B. Lancet II: 945–947

    Google Scholar 

  46. Smedile A, Lavarini C, Farci P, Arico S, Marinucci G, Dentico P, Guiliani G, Cargnel A, Vecchio Blanco C del, Rizzetto M (1983) Epidemiologic patterns of infection with the hepatitis B virus-associated delta agent in Italy. Am J Epidem: 117: 223–229

    Google Scholar 

  47. Snydman DR, Werner BG, Heinze-Lacey B, Berardi VP, Tilney NL, Kirkman RL, Milford EL, Cho SI, Bush HL, Levey As, Strom TB, Carpenter CB, Levey RH, Harmon WE, Zimmerman CE, Shapiro ME, Steinman T, LoGerfo F, Idelson B, Schröter GPJ, Levin MJ, McIver J, Leszczynski J, Grady GF (1987) Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N Engl J Med 317: 1049–1054

    Google Scholar 

  48. Stephan W, Prince AM (1981) Efficacy of combined treatment of factor IX complex (PPSB) with beta-propiolactone (beta-PL) and ultraviolet (UV) irradiation. Haemostasis 10: 67

    Google Scholar 

  49. Stevens CE, Aach RD, Hollinger FB, Mosley JW, Szmuness W, Kahn RA, Werch J, Edwards V (1984) Hepatitis B virus antibody in blood donors and the occurrence of non-A, non-B hepatitis in transfusion recipients. Ann Int Med 101: 733–738

    Google Scholar 

  50. Sugg U, Schenzle D, Hess G (1988) Antibodies to hepatitis B core antigen in blood donors screened for alanine aminotransferase level and hepatitis non-A, non-B in recipients. Transfusion 28: 386–388

    Google Scholar 

  51. Tegtmeier GE (1986) Transfusion-transmitted cytomegalovirus infections: significance and control. Vox Sang 51: 22–30

    Google Scholar 

  52. Tremolada F, Chiapetta F, Noventa F, Valfrè C, Ongaro G, Realdi G (1983) Prospective study of posttransfusion hepatitis in cardiac surgery patients receiving only blood or also blood products. Vox Sang 44: 25–30

    Google Scholar 

  53. Tur-Kaspa R, Shimon DV, Shalit M, Adler R, Shraga S, Manny N, Morag A, Eliakim M (1983) Posttransfusion non-A, non-B hepatitis after cardiac surgery: a prospective study. Vox Sang 45: 312–315

    Google Scholar 

  54. Walsh JH, Purcell RH, Morrow AG, Chanock RM, Schmidt PJ (1970) Posttransfusion hepatitis after open-heart operations. Jama 211: 261–265

    Google Scholar 

  55. Widell A, Sundström G, Hansson BG, Fex G, Moestrup T, Nordenfelt E (1988) Relation between donor transaminase and recipient hepatitis non-A, non-B in Sweden. Vox Sang 54: 154–159

    Google Scholar 

  56. Wong VCW, Ip HMH, Reesink HW, Lelie PN, Reerink-Brongers EE, Yeung CY, Ma HK (1984) Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. A double blind randomised placebo-controlled study. Lancet I: 921–926

    Google Scholar 

  57. Yeager AS (1974) Transfusion-acquired cytomegalovirus infection in newborn infants. Am J Dis Child 128: 478–483

    Google Scholar 

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  1. Amsterdam Red Cross Blood Bank, P.O. Box 9137, NL-1006 AC, Amsterdam, The Netherlands

    H. W. Reesink & C. L. van der Poel

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Reesink, H.W., van der Poel, C.L. Blood transfusion and hepatitis: still a threat?. Blut 58, 1–6 (1989). https://doi.org/10.1007/BF00320227

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